Pecularities of total gastrectomy for treatment of gastric cancer


Arūnas Petkevičius1, Rytis Tumasonis1, Andrius Čitavičius2

1 Lithuanian University of Health Sciences, Department of Surgery

2 Lithuanian University of Health Sciences, Medicine Faculty



Stomach cancer is the 5th most common neoplasm and the 3rd most deadly cancer in the world. Surgery is the primary treatment of gastric cancer. Subtotal resection is performed when the tumour is in distal part of the stomach and total gastrectomy is performed when cancer is in the middle or proximal part of the stomach.

Gastric cancer usually does not have any specific symptoms. Symptoms usually differ depending on localization of tumor, growth characteristics, morfologic structure, invasion to the surrounding organs.

Usually extended R0 resection with D2 lymphanedectomy is performed when choosing the surgical treatment for gastric cancer.

Longer survival rates are achieved when subtotal resection is used to treat distal gastric cancer in comparison with total gastrectomy. However survival rates are similar when the tumour is localized in antrum.

Studies have shown that better results are achieved when laparoscopic total gastrectomy is performed in comparison with open total gastrectomy. On the other hand, laparoscopic approach can cause spreading of the cancer because of the increased intraabdominal pressure during the operation. What is more, cancer cells can spread via laparoscopic surgical equipment.

During the first five years after total gastrectomy the most frequent side effects are diarrhea, dysphagia, increased acid and eating problems. Total gastrectomy is also associated with worse quality of life than subtotal resection.

Total gastrectomy can also be performed in 18-40 year people who have the mutation of CDH1 gene.

Total gastrectomy combined with chemotherapy is also recommended to treat advanced gastric cancer because longer survival rates are achieved than using only palliative treatment.

Total gastrectomy is associated with increased risk for tuberculosis because of weakened immunity, poor nutrition and malabsorbtion after the operation.

Keywords: Tumor, gastrectomy, stomach, cancer.